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Revisiting the basic reproductive number for malaria and its implications for malaria control

Revisiting the basic reproductive number for malaria and its implications for malaria control

Smith DL., McKenzie FE., Snow RW., Hay SI.

The prospects for the success of malaria control depend, in part, on the basic reproductive number for malaria, R0. Here, we estimate R0in a novel way for 121 African populations, and thereby increase the number of R0estimates for malaria by an order of magnitude. The estimates range from around one to more than 3,000. We also consider malaria transmission and control in finite human populations, of size H. We show that classic formulas approximate the expected number of mosquitoes that could trace infection back to one mosquito after one parasite generation, Z0(H), but they overestimate the expected number of infected humans per infected human, R0(H). Heterogeneous biting increases R0and, as we show, Z0(H), but we also show that it sometimes reduces R0(H); those who are bitten most both infect many vectors and absorb infectious bites. The large range of R0estimates strongly supports the long-held notion that malaria control presents variable challenges across its transmission spectrum. In populations where R0is highest, malaria control will require multiple, integrated methods that target those who are bitten most. Therefore, strategic planning for malaria control should consider R0, the spatial scale of transmission, human population density, and heterogeneous biting.